Acne fulminans e isotretinoína: relato de caso

Abstract

Acne fulminans (AF) is a rare disorder, the most severe form of the entire clinical spectrum of acne. It is characterized by emergence of painful inflammatory nodules that turn into ulcers, concomitant with systemic manifestations. It can be induced by isotretinoin and some authors believe that the occurrence of this condition is dose dependent. The treatment is controversial and there is no consensus up to this time. A case of this rare disease, developed during use of isotretinoin in low doses, is presented. Keywords: Acne vulgaris; Retinoids; Therapeutics Resumo: A acne fulminans é afecção rara e a forma mais grave de todo o espectro clínico da acne. Caracterizase pelo aparecimento súbito de nódulos inflamatórios dolorosos que ulceram, concomitantemente, a manifestações sistêmicas. Pode ser induzida pela isotretinoína e alguns autores acreditam que a ocorrência do quadro seja dose dependente. O tratamento é controverso, não havendo padronização até o momento. Apresenta-se caso desta rara doença, desenvolvida durante o uso de isotretinoína em baixas doses.

Acne fulminans in a Vietnamese boy successfully treated with prednisolone and ibuprofen: A case report

“…However, it is thought to be an immunologically induced, systemic disease in which the triggering antigen is believed to be from Propionibacterium acnes. This bacterium can start to behave as a superantigen, triggering an exaggerated and disorganized antibody response, resulting in the alarming inflammatory symptoms 3,6 . Some reports have shown that almost all AF patients are male adolescents, suggesting that high blood testosterone levels during puberty may play an important role in the pathogenesis of acne fulminans.…”

“…Some reports have shown that almost all AF patients are male adolescents, suggesting that high blood testosterone levels during puberty may play an important role in the pathogenesis of acne fulminans. Another theory is that AFs could be associated with an autoimmune etiology and genetic factors 3,4,6 . Normally, blood culture tests of AF patients are negative.…”

“…The systemic symptoms include high fever and polyarthralgia 1,2 . AF mainly affects young male adolescents with a history of acne vulgaris 3,4 . Laboratory findings typically show blood count abnormalities, with leukocytosis and neutrophilia, as well as elevated erythrocyte sedimentation rate and elevated C-reactive protein (CRP).…”

Paradoxes in dermatology

“…However, isotretinoin must be used with caution, as paradoxical induction/exacerbation of acne fulminans has been reported. [113–115]…”

Acne fulminans: a rare form of acne

“…Acne fulminans is a rare and severe ulcerative form of acne with an acute onset and systemic symptoms, mainly affecting young male aged 13-22 years, with history of acne vulgaris [1]. It is characterized by rapid onset of painful inflammatory nodules in the habitual areas of acne, which become suppurative, ulcerated and covered by hemorrhagic crusts [2]. The trunk is strongly affected, especially the back, but also the shoulders and face [3].…”